Institute: ONC | Component: 2 | Unit: 7 | Lecture: c | Slide: 14
Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Quality Measurement and Improvement
Lecture:Role of IT and informatics Results of current approaches to quality assessment
Slide content:Better Performance on Measures = Better Outcomes? No Process measures in hospitals predict small differences in mortality in MI, CHF, and pneumonia (Werner & Bradlow , 2006) CHF measures of ACC/AHA have little relationship to mortality or rehospitalization rates ( Fonarow et al., 2007) Participation of hospitals in MI P4P quality effort did not improve quality of care or better outcomes (Glickman et al., 2007) Smoking cessation quality metric did not correlate with actual smoking cessation (Reeves et al., 2008) Door-to-balloon measure for acute MI not correlated with other quality measures or mortality (Wang et al., 2009) CMS heart failure measures not associated with better outcomes (Patterson et al., 2010) 14
Slide notes:Unfortunately, the story does not end there. Other studies have produced negative findings. One, for example, found that across various quality process measures, hospitals could predict only small differences in mortality from MI, CHF, and pneumonia. Another study found that the measures for quality of care of CHF developed by the American College of Cardiology and the American Heart Association have little relationship to mortality or re-hospitalization rates. Perhaps one of the most negative studies showed that hospitals that participated in a particular P4P quality effort didnt produce an improved quality of carethe hospitals didnt do any better in the quality measures, and of course, none of the patients had better outcomes. Other studies have been negative as well. In one, a smoking cessation quality metric didnt correlate with actual smoking cessation. In another, a door-to-balloon measure for acute MI didnt correlate with other quality measures or mortality. Finally, use of Centers for Medicare and Medicaid Services (CMS, [C-M-S]) heart failure measures has not been associated with better outcomes. 14